Student Information and Permissions Form

Please fill out this form in its entirety for our records here at SJVTC.

Student's Mailing Address

Contact Person For This Student

Field Trip Permission Section

The student named above has my permission to participate in field trips to local facilities within the immediate area. I understand that these trips will be arranged by Technology Center Staff, and will be supervised at all times.

Statement of Accident Insurance Coverage

It is the policy that every SJVTC student who participates in our Technology Programs and associated activities has some type of accident insurance coverage. Please provide the information requested.

Permission to Operate Power Equipment

This student has my permission to operate equipment, tools and machines as part of their Technology Center Education. I fully understand that any and all of the machines are potentially dangerous if operated in a careless way. I have explained and discussed this with my child and they understand the risks involved with working with power equipment. At all times, my child agrees to follow the directions of the instructor in charge of the program.

As a student, I assume responsibility for for the following safe practices:

1. I will follow safety rules for the shop.

2. I will never use a machine without first obtaining instructor permission.

3. I will not ask permission to use a particular machine unless I have been instructed in its use and have earned 100% on the safety test for that machine.

4. I will report any accident or injury to the instructor immediately.

By initialing below you give consent (permission).

Media Release Section

I, the parent/guardian of the Student named above, understand they may photographed, video recorded, and/or voice recorded and for their name, image, likeness, and voice to be used in photographs, videos, publications, internet, news, and social media and web pages for special projects or publicity by the School.

I am aware that the Student may be asked a variety of questions concerning the School and school-related activities and programs, and that the contents of the interview may be published or aired publicly. I understand that the Student will be under the supervision of a school staff member during the interview or photo session. There may not be school staff supervision, however, if the photographs, video recordings, or voice recordings are part of a general background scene in which my child is not identified.

The Student reserves the right to refuse to answer any questions or participate in any discussions that make them feel uncomfortable or embarrassed. Additionally, the Student or the supervising school agent reserves the right to terminate the interview or photo or video

session at any time for any reason.

I understand that neither the School nor the news media has any obligation to air or publish the image, photos, video recordings, or voice of the Student. I also understand that neither I nor the Student will receive any monetary compensation for the rights granted herein, and I understand that the Student's appearance or the use of their voice in any digital or printed media format does not confer any ownership rights on me or the Student.

If by reason of the Student's statements and actions in the interview, photos, images, video or voice recordings, or the materials furnished to the Student by anyone other than the School for the same, there is any claim or litigation involving any charge by third parties of violation or infringement of their right, I agree to indemnify and hold harmless the School, its staff, the Board of Education and its licensees and assignees from liability, loss, or expenses arising from such claim or litigation.

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